Provider Demographics
NPI:1649253105
Name:DOUGLAS COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:DOUGLAS COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUEPPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-683-4174
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:BUILDING C
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-0940
Mailing Address - Country:US
Mailing Address - Phone:417-683-4174
Mailing Address - Fax:417-683-4111
Practice Address - Street 1:603 NW 12TH ST
Practice Address - Street 2:BUILDING C
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-0940
Practice Address - Country:US
Practice Address - Phone:417-683-4174
Practice Address - Fax:417-683-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local